title: Impact of cardiovascular magnetic resonance on management and clinical decision-making in heart failure patients.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) can provide important diagnostic and prognostic information in patients with heart failure. However, in the current health care environment, use of a new imaging modality like CMR requires evidence for direct additive impact on clinical management. We sought to evaluate the impact of CMR on clinical management and diagnosis in patients with heart failure.
  
  
  METHODS
  We prospectively studied 150 consecutive patients with heart failure and an ejection fraction ≤ 50% referred for CMR. Definitions for "significant clinical impact" of CMR were pre-defined and collected directly from medical records and/or from patients. Categories of significant clinical impact included: new diagnosis, medication change, hospital admission/discharge, as well as performance or avoidance of invasive procedures (angiography, revascularization, device therapy or biopsy).
  
  
  RESULTS
  Overall, CMR had a significant clinical impact in 65% of patients. This included an entirely new diagnosis in 30% of cases and a change in management in 52%. CMR results directly led to angiography in 9% and to the performance of percutaneous coronary intervention in 7%. In a multivariable model that included clinical and imaging parameters, presence of late gadolinium enhancement (LGE) was the only independent predictor of "significant clinical impact" (OR 6.72, 95% CI 2.56-17.60, p=0.0001).
  
  
  CONCLUSIONS
  CMR made a significant additive clinical impact on management, decision-making and diagnosis in 65% of heart failure patients. This additive impact was seen despite universal use of prior echocardiography in this patient group. The presence of LGE was the best independent predictor of significant clinical impact following CMR.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood St, M/C 715, Suite 920 S, Chicago, IL 60612, USA. afshin@uic.edu.
authors.forename: Siddique A
authors.initials: SA
authors.lastname: Abbasi
authors.forename: Andrew
authors.initials: A
authors.lastname: Ertel
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.forename: Vineet
authors.initials: V
authors.lastname: Dandekar
authors.forename: Jaehoon
authors.initials: J
authors.lastname: Chung
authors.forename: Geetha
authors.initials: G
authors.lastname: Bhat
authors.forename: Ankit A
authors.initials: AA
authors.lastname: Desai
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
authors.forename: Afshin
authors.initials: A
authors.lastname: Farzaneh-Far
mesh_terms: D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left